Local muscular spasms
Blepharospasm
During the injection, the patient is in a sitting position, the back of the head is propped against a fixed support. The drug is injected shallowly into the m. Orbicularis oculi, the closer to the eye, the more superficial (intradermal) in 4-5 points. At a typical blepharospasm in 2 points of the upper eyelid, located medial and lateral from the vertical pupillary line, and 2-3 points in the area of the outer corner of the eye. In the course of the pretarsal blepharospasm, injection points in the upper eyelid area are located in the lower part of the upper eyelid directly near the line of eyelash growth.
Avoid injection in the middle of the upper eyelid and the inner corner of the eye because of the risk of side effects (ptosis, lacrimation, diplopia).
The total dose for bilateral blepharospasm in most cases is 25 units per eye. In the case of unilateral blepharospasm, injections are performed only on the side of the affected eye.The initial dose for each point is 2.0-3.0 units. The maximum dose for each point is 5.0 units. With pretarsal blepharospasm, at every point of the upper eyelid, no more than 2.0-2.5 units of ED are injected, in the region of the outer corner of the eye - according to the usual scheme.
Use insulin syringes with non-removable needles measuring 29-33G.
After injection for 5 minutes it is recommended to cool the area of injections (near the outer eye) with bags of ice cubes. For a more rapid and persistent onset of the drug, the patient is recommended to actively shut his eyes and open his eyes within 15-20 minutes. Repeated injections are carried out as needed, but not earlier than 2 months.
Gemifacial spasm
The treatment of hemifacial spasm by Lantox is generally similar to the treatment of blepharospasm. The dose of Lantox with an injection only around the eye does not exceed 25 units per side.
In the muscles of the corner of the mouth (large and small zygomatic muscles) inject 2.5 LTU of Lantox; an increase in the dose may be complicated by lowering the angle of the mouth. To maintain the symmetry of the mouth, it is possible to correct the injection into these muscles from the opposite ("healthy") side. In the prevalent variants of hemifacial spasm with the involvement of the frontal muscle, the muscles of the brow frown and platysm are additionally introduced into each muscle by 5-10 units.
The total dose of Lantox in the prevalent variants of hemifacial spasm per procedure is 50 units or more. The maximum dose is determined individually and is the sum of the doses for each muscle involved.
Use insulin syringes with non-removable needles measuring 29-33G. Repeated injections are carried out as needed, but not earlier than 2 months.
Spasticity of the muscles of the upper limb
Spasticity in the area of the hand
During the injection, the patient is in a sitting position on the stool or lying on his back, the hand lies on the horizontal plane.
The average therapeutic dose of Lantox with abnormal flexural settings of the hand and fingers is 150 units. The total dose is divided between m. Flexor carpi radialis - 20-40 units, m. Flexor carpi ulnaris - 20-40 units, t. Flexor digitorum superficialis 20-40 units, m. Flexor digitorum profundus - 30-60 units.
For injections use insulin syringes with non-removable needles of size 29-33G, as well as needles for intramuscular injections of size 21-23G and EMG control. Repeated injections are carried out after 3-4 months.
Spasticity in the elbow joint area (flexion in the elbow joint)
The average therapeutic dose of Lantox with a flexor in the elbow joint is 100-200 units. The total dose is distributed between the muscles: m. Biceps brachii - 50-100 ED, m.Brachialis - 25 units, m. Brachioradialis - 25 units. The injection is performed by the needles for intramuscular injections of 21 and 23G. EMG control is not required due to superficial muscle arrangement.
Repeated injections are carried out after 3-4 months.
Spasticity in the shoulder region (reduction of the shoulder and its internal rotation)
During the injection the patient is in a sitting position. The average therapeutic dose of Lantox with shoulder reduction and its internal rotation is 150-250 units. The total dose is distributed between the muscles: w. Pectoralis major - 75 units, m. Teres major - 25 units, m. Subscapularis is 25 units and m. Latissimus dorsi - 25-50 units.
Injections are performed with needles of size 21-23 G, EMG control is required. Repeated injections are carried out after 3-4 months.
Spasticity of the muscles of the lower limb
Spasticity in the foot (equinovarus deformation of the foot)
The total dose of Lantox with equinovarus deformation of the foot is 200 units. If the drug is administered only in m. Gastrocnemius, then its dose is 100-150 units. The entire dose is distributed to the 2 head of the calf muscle and is inserted into 4 points (2 points per head). Injections are performed with a needle length of at least 4 cm. As a rule, EMG-control is not required. Injections are performed intramuscularly in the proximal quarter and distal 3/4 of the gastrocnemius muscle, or in the proximal 1/3 and distal 2/3 muscles.
In those cases when the leading value in spasticity has an increased tone m. Soleus, the total dose of the drug administered is 50-100 units. In those cases when spasticity is caused by a high tone of both the gastrocnemius and soleus muscle, it is necessary to inject Lantox into both these muscles in a dose of 150-300 units.
If the varus component dominates in the deformation of the foot, then it is necessary to carry out the combined introduction of Lantox as in m. Gastrocnemius in a dose of 100-150 ED, and in m. Tibialis posterior in a dose of 50-100 units. To maintain the effect, it is necessary to repeat injections, but not earlier than 2 months.
The most commonly injected muscles are: m. Gastrocnemium, m. Soleus and Tibialis posterior (total dose 150 - 300 units).
The average therapeutic dose for m. Gastrocnemius is 100-150 units. The total dose is distributed between the 2 heads of the gastrocnemius muscle and is introduced into 4 points (2 points per head). Injections are performed with a needle with a length of 23G. As a rule, EMG-control is not required.
The average therapeutic dose for m. Soleus is 50-100 units. Injections are performed with a needle measuring 21G in length. As a rule, EMG-control is not required.
The average therapeutic dose for Tibialis posterior is 50-100 units. EMG control is required. Repeated injections are carried out in 3-4 months.
Spasticity in the knee region
Equine deformity can be combined with spasticity of the posterior group of hip muscles leading to flexion contracture of the knee joint. In these cases, Lantox should be injected into the semitendinous and semimembranous muscles at a dose of 50-100 ED in 1-2 points of each muscle.
Injections in m. Semitendinosus and m. Semimembranosus is performed by intramuscular needles of a size of 21 G, EMG monitoring is generally not required.
If the spasticity of the quadriceps muscle dominates, an extension knee in the knee joint is formed. It is recommended that the drug is injected into the straight and lateral heads m. Quadriceps femoris in a total dose of 100-150 units.
Injection into the rectum and lateral head m. Quadriceps femoris is performed with a needle 5-7 cm long, EMG monitoring is usually not necessary, because the muscles are superficially and well palpated. Repeated injections are carried out after 3-4 months. Spasticity in the hip area
With spasticity in the proximal muscles of the femur - ilio-lumbar and rectus muscle of the thigh, Lantox is injected into m. Iliopsoas in a dose of 100-150 units. If necessary, additional injections into m can be made. Rectus femoris in a dose of 50-100 units.
Injection into m.Iliopsoas perform a long needle - up to 10 cm, it is desirable to conduct EMG-control due to the deep arrangement of the muscle. The injection point is 3-4 cm lateral to the pulsation of the femoral artery, immediately below the inguinal ligament; depth of injection up to 7-8 cm. Repeated injections are carried out after 3-4 months.
Hyperactive Bladder
Produce endoscopic injection of the drug wall of the bladder under a constant visual control of 20-30 points per 1 ml at a rate of 10 units per 1 point of administration. The maximum dose of administration is 300 units.
Detruzor-sphincter dissynergy
External sphincter of the bladder (non-relaxing external sphincter of the urethra, detrusor-sphincter dissynergy)
Lantox is administered transurethral or transperineal to the external urethral sphincter at a dose of 100 units under EMG control. The volume of the administered solution should not exceed 8 ml, and the dose of the injected drug should not exceed 100 units. Repeated injections are performed as needed, usually every 6-12 months.
Sphincters of the rectum (paradoxical pu-rectal dissynergy, anal fissures, constipation)
Lantox is injected into two points of each pu-rectal muscle in a total dose of 50-100 ED.To relax the internal anal sphincter, Lantox is injected into the anterior part of the sphincter under the control of EMG. The average dose is 20 units.
With spasticity of perineal muscles, manifested by vaginismus, anemia, or anal fissure, the drug is administered transperineally.
When vaginismus the drug is injected into the front wall of the vagina at a dose of 30-50 units.
When anism (pathological spasm of the puborectal muscle) in a dose of 25-50 units per each puborectal muscle from both sides.
When anal fissure Lantox injections are performed in the anterior part of the internal anal sphincter at a dose of 20 units.
Repeated injections are performed as needed, usually every 6-12 months.
Hyperfunctional facial wrinkles
Forehead area
Injections are made at a distance of 2-2.5 cm from the eyebrows. The injection points (usually 4-8 points) are located at an interval of 2 cm from each other. Injections are performed symmetrically, subcutaneously or intramuscularly, with the same dosage to avoid asymmetry of the eyebrows. The dose to each point is 2.0-4.0 units, the total dose: 8-32ED.
Wrinkles in the bridge of the nose (between the eyebrows)
If the patient has a deep and long inter-brow furrow, an additional 2.5-5.0 ED is administered at points located 5-7 mm above the primary points.The depth of needle insertion is 2-3 mm, the direction is vertical downwards.
In addition, an additional injection is made to a point located in the center of the line connecting the medial edges of the eyebrows. The dose to this point is 2.5 to 7.5 units, depending on age and sex. Needle position - from front to back, depth of needle insertion - 2-3 mm. The total amount of the drug injected into the area between the eyebrows should not exceed 25 units.
Wrinkles at the outer corners of the eyes
Injections are administered subcutaneously in 2-4 points located 1.5 cm from the lateral angle of the eye, located symmetrically in the outer segment of the area, at a distance of 1-2 cm from each other, depending on the number of wrinkles in the patient. The dose to each point is 1.5-4 units, the total dose: 3-16 units per side.
Wrinkles in the area of the back of the nose
In this area, injections are made at 2 points symmetrically in the region of the back of the nose intradermally. The dose to each point is 1.5-2 units, the total dose: 3.0-4.0 units.
Along with the above-mentioned zones of Lantox administration, correction is sometimes required: above the upper lip to correct the vertical ("muscular") Lantox wrinkles (injected subcutaneously / intramuscularly into one point in the middle of the upper lip) or two points closer to the vermilion area, 5 mm from the red border of the lips; in the muscle, lowering the corners of the mouth (triangular muscle, m.Depressor anguli oris), to raise the corners of the mouth and reduce the severity of the lip-chin fold ("folds of sorrow"), Lantox is injected intradermally, at a distance of 1 cm from the edge of the lower jaw, to the projection point of the maximum activity of this muscle, at a dose of 2-3 units; for lifting the side facial (correction of the face oval) Lantox is injected subcutaneously in two points along the edge of the lower jaw at a distance of 2 cm from each other, at a dose of 2-3 units per point; in the field of the muscle of laughter to correct vertical wrinkles ("staples") lateral to the nasolabial fold Lantox is injected intradermically into 1-2 points located along the line of the corners of the mouth 2-3 cm lateral to the nasolabial fold; in the neck region for the correction of strands m. Platyzma Lantox is injected intramuscularly into the middle of each visible strand at a dose of 3-5 units per point.
In these points Lantox is also administered in the presence of pathological syncopeies and contractures. To improve the relief of the anterior surface of the neck, Lantox is injected into an additional 4-6 points subcutaneously / intradermally at a dose of 1-2 units per point.
Syncopeesis and contracture of facial muscles
The injection points in the treatment of syncopeesis and contracture are identical to the points of hemifacial spasm, however, the dose of Lantox at each point and the total dose per procedure should be 25-50% lower.
Strabismus
In the treatment of strabismus, Lantox is injected with a coaxial electrode needle, electromyographic control under local anesthesia using 0.5% of dicain. Injections into the extraocular muscles are selected in accordance with the type of strabismus.
For vertical and horizontal muscular strabismus with deviations less than 20 prism diopters, the initial dose to each muscle should be 1.25-2.5 units, for horizontal strabismus with deviations of 20-40 prisms diopters, the dose to each muscle is 2.5- 5 units, for horizontal strabismus with deviations 40-50 prisms diopters, the initial dose in each muscle is 2.5 units and can be increased (up to 5 units each time) depending on the effect. In the treatment of persistent paralysis of the cranial nerve VI, lasting more than 1 month, a dose of 1.25-2.5 units may be introduced into the medial rectus muscle.
To create protective ptosis in patients with lagophthalmosis, Lantox is injected into the zone of the projection of the muscle lifting the upper eyelid in the middle of the upper eyelid intradermally, at a dose of 10-20 units.
Vegetative disorders
Hyperhidrosis
The minimum dose is 0.5 units per 1 cm2, with intensive hyperhidrosis to 1-2 ED per 1 cm2. The recommended volume of the drug administered in one zone should not exceed 50 units.
Injections are performed intradermally with an insulin syringe with non-removable needles measuring 29-33G.
The distance between injection points is 1.5-2 cm, 2.0 units are injected into each point; the maximum dose for each point is 5.0 units (for areas with a particularly intense hyperhidrosis). The average dose for injection of one typical zone (palm, foot or armpit) in most cases is 50 units; the minimum dose is 30 units of Lantox. The average number of points for one typical zone is from 15 to 25.
Repeated injections are carried out as needed, but not earlier than 2 months.
Pain syndromes
Myofascial pain syndromes
Myofascial pain syndrome of the face. Myogenic painful dysfunction of the temporomandibular joint.
Lantox is injected on the side of pain in the temporal muscles (10-30 units each), in the masticatory muscles (20-50 units each) and, if necessary, in the pterygoid muscles (10-40 units each). If bilateral injections are necessary, the total dose of the drug should be reduced.
Upper chest aperture syndrome
Lantox is introduced into the front staircase (in the central part) or into the small pectoral muscle into two trigger points (TT); in addition - in the TT of the large pectoral muscle. The total dose is 75-100 units.It is recommended simultaneous injection of 3-4 ml of local anesthetic.
The needle is positioned perpendicular to the skin surface 3.8 cm above the clavicle (up to 2.5 cm above the collarbone there is a risk of injuring the pleura).
Syndrome of shoulder-scapular periarthropathy
Injections of Lantox in a total dose of 100-200 units are carried out in 2-5 most interested TT of the following muscles: supratenal, deltoid, subscapular, large round muscle. Possible simultaneous administration of up to 5 ml of local anesthetic.
Mandatory injections in 2-3 TT of the supraspinous muscle, which are carried out with a needle 3-4 cm long. The medial TT is located above the spine of the scapula 2-3 cm outward from the medial margin; lateral TT - between the scapula and the clavicle at the medial edge of the acromion.
"Tennis Elbow". Lantox in a dose of 20-40 units is injected under the EMG-control into the muscle of the common extensor of the fingers in combination with a local anesthetic.
Pear-shaped muscle syndrome. Lantox is administered at a dose of 80-100 ED to the point located at the border of the lateral 1/3 line connecting the sacrum and the large spit; depth of injection up to 7 cm.
With myofascial pain in the lumbar region, Lantox is injected into the pear-shaped, ilio-lumbar, square muscle of the waist with a dilution of 0.9% sodium chloride solution for injection. Simultaneously, the administration of an anesthetic is possible.It is advisable to inject under EMG control due to a deep muscle arrangement.
The ilio-lumbar muscle: Lantox is administered at a dose of 100-150 ED to a point 3-4 cm lateral to the pulseless femoral artery, immediately below the inguinal ligament; depth of injection up to 7-8 cm.
Square lumbar muscle: Lantox is administered at a dose of 100 units at 2-4 points corresponding to TT.
Trism, bruxism. If the mouth is difficult to open, injections are done in three muscles (doses for one side are given): m. Temporalis - 20 units (10-50 units), t. Pterygoideus lateralis - 30 units (20-40 units), m. Masseter - 40 units (30-100 units). EMG control may be required. With a second injection, the dose of Lantox is usually 25% lower. It is permissible in cases of acute pain to inject Lantox solution together with 2 ml of a 2% solution of lidocaine.
Chronic facial pain. When dislocation and dyslexia of the temporo-maxillary joint, Lantox should be inserted into both mm. Pterygoidei lateralis in a dose of 20 units on each side.
Chronic headaches
Treatment with Lantox is indicated for: severe migraine (more than 8 migraine attacks per month); chronic migraine; chronic tension headache with involvement of pericranial muscles; chronic daily headaches caused by a combination of different types of headaches (combined chronic headaches);tension of pericranial and cervical muscles; cervicogenic headaches; inefficiency of standard schemes of drug preventive therapy - as a "backup" therapy for chronic headaches. Each of the above indications individually is sufficient for the application of Lantox.
Injections are produced in m. Procerus, bilateral in mm. Frontalis, Corrugator supercilii, Temporalis, Occipitalis. When performing injections in mm. Frontalis the lower points of the Lantox injection should be located 2 cm above the eyebrow line. In addition, mm is injected. Trapezius, Splenius capitis, Sternocleidomastoideus in cervicogenic and combined chronic headaches.
Breeding Lantox - in 2.0 ml of a 0.9% solution of sodium chloride for injection at 100 units.
Used insulin syringes with non-removable needles size 29-33G.
The total dose of Lantox, equal to the sum of doses for all target muscles, is determined individually in each case. The dose depends on the type of headache, the severity of the patient's general condition, and the size of the injection areas (head or head and neck area).
The number of injection points and dose values are indicated in Table 2.
Table 2. Doses of Lantox for injection into muscles in chronic headaches.
| Target muscles | Average dose * (ED) | Range of doses * (ED) | amount points introduction * |
| Frontal | 4 | 3-10 | 2-3 |
| Eyebrow Frown | 5 | 4-15 | 1-2 |
| Gordecov | 5 | 4-8 | 1-2 |
| The temporal | 15 | 5-30 | 2-4 |
| Occipital | 8 | 5-20 | 2-3 |
| Trapezoidal (rarely) | 25 | 20-40 | 2-4 |
| Belt head (rare) | 25 | 20-40 | 2-3 |
| Kivatelnaya (rarely) | 20 | 15-30 | 2-4 |
* - doses and points for one side are presented. When calculating the total dose of injections, it is necessary to take into account the bilaterality of the drug administration.
Injections are performed with insulin syringes with non-removable needles measuring 29-33G.
Treatment, as a rule, begins with the use of the average dose recommended for the target muscle.
The average total dose per procedure for one patient is 100 units, the maximum is 200 units.
Clinical improvement in the form of an analgesic effect is observed at the end of the first month after the injection and persists for 3-6 months. If the effect of the first procedure is inadequate, repeated administration of Lantox in a larger dose after 3 months is recommended. To achieve a stable improvement, repeated injections are given once every 3-6 months.
Dissolution of the preparation
The preparation is dissolved with sterile isotonic sodium chloride solution for injection 0.9% in the required volume, according to the table.
| ED / 0.1 ml | Number of units in the vial |
| 50 | 100 |
| Volume of solvent (ml) |
| 10,0 | 0,5 | 1,0 |
| 5,0 | 1,0 | 2,0 |
| 2,5 | 2,0 | 4,0 |
| 1,25 | 4,0 | 8,0 |
When diluting the drug, it is forbidden to open the bottle, removing the stopper. Before diluting the contents of the vial, the central part of the rubber plug is treated with alcohol. For a puncture use a sterile needle size 23-25 G. The solvent should be injected through the wall, by means of light rotational movements of the vial the powder is mixed with the solvent for one minute. After the addition of the solvent, the vial is gently rocked until the drug dissolves completely. If the solvent is not drawn into the vial under the action of a vacuum, the vial is destroyed. The dissolved preparation should be transparent and colorless, without extraneous inclusions. The prepared injectable solution is injected with an insulin syringe, the size of the needle is determined by the size of the muscle and the depth of injection.
The solution should be used immediately or stored in the cold at a temperature of 2 ° C to 8 ° C for no more than 4 hours. The container and syringe, as well as the remaining drug solution, are subject to destruction after sterilization. The dispensed product is to be neutralized with a solution of sodium hypochlorite.